Individual
MS. LACANDA WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1507 E 53RD ST, SUITE 283, CHICAGO, IL 60615-4509
(773) 837-4163
(708) 798-2454
Mailing address
1507 E 53RD ST, SUITE 283, CHICAGO, IL 60615-4509
(773) 837-4163
(708) 798-2454
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36435163002
—
IL
Enumeration date
08/09/2007
Last updated
08/09/2007
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